Continued E-cigarette Use Research Articles

Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults.

Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.

Social Media Use and Subsequent E-Cigarette Susceptibility, Initiation, and Continued Use Among US Adolescents.

Social media has a large amount of e-cigarette content. Little is known about the associations between social media use and a wide range of e-cigarette use behaviors, including susceptibility, initiation, and continued use. We analyzed national data on US adolescents to assess these associations. We used data on adolescents participating in the Population Assessment of Tobacco and Health (PATH) Study Wave 4 (2016-2018) and Wave 5 (2018-2019). We conducted 2 models: 1) a multinomial logistic regression on e-cigarette use susceptibility and use behaviors at Wave 5 by social media use at Wave 4 among adolescents who never used e-cigarettes at Wave 4 and 2) a binomial logistic regression on current e-cigarette use at Wave 5 by social media use at Wave 4 among adolescents who ever used e-cigarettes at Wave 4. Among adolescents who never used e-cigarettes at Wave 4 (n = 7,872), daily social media use (vs never) was associated with a higher likelihood of being susceptible to e-cigarette use (adjusted odds ratio [aOR] =1.46; 95% CI, 1.20-1.78), past e-cigarette use (aOR = 3.55; 95% CI, 2.49-5.06), and current e-cigarette use (aOR = 3.45; 95% CI, 2.38-5.02) at Wave 5. Among adolescents who ever used e-cigarettes at Wave 4 (n = 794), we found no significant association between social media use at Wave 4 and continued e-cigarette use at Wave 5. Our study found that social media use is associated with subsequent susceptibility to e-cigarette use and initiation but not with continued use of e-cigarettes among US adolescents. These findings suggest that understanding and addressing the association between social media and e-cigarette use is critical.

Monitoring website marketing among leading e-cigarette brands and vendors in California: content analysis

BackgroundElectronic cigarette (e-cigarette) brands and vendors use websites to promote pro-tobacco messages that may increase susceptibility to use e-cigarettes among never users or help sustain continued e-cigarette use among current...

How Age and E-cigarette Use Status Interact to Influence E-cigarette Ad Perceptions

Background: The prevalence of e-cigarette use among young people remains high. Young people are susceptible to e-cigarette advertising, although potential heterogeneity in perceptions of e-cigarette ads with respect to age and e-cigarette use history remains unexplored. We aimed to assess differences in perceptions of e-cigarette ads and product use intention, by age and e-cigarette use status. Methods: Participants from an online convenience sample (N = 497, M age=31.9) viewed two randomly selected e-cigarette ads and reported their perceptions of the ads and product use intention. We used mixed effects linear regression models to estimate associations between age group (18–20 years, 21–25 years, 26+ years), e-cigarette use status (never, former, and current use), and their interaction effects, on outcomes related to perceptions of ads and use intention. Models controlled for demographics and other tobacco use. Results: Current e-cigarette users (vs. never users) and participants who were 26+ years old (vs. 18–20 years old) had greater liking of the ads, perceived ad relevance, and perceived ad effectiveness. Among current e-cigarette users, participants who were 26+ years old (vs. 18–20 years old) had lower use intention. Conclusion: The effect of e-cigarette ad exposures on perceptions of the ad and use intention is heterogeneous with respect to age group and e-cigarette use history. While ads appealed more to adults who were 26+ years old across e-cigarette use groups, current e-cigarette users who were 18–20 years old demonstrated high use intention following ad exposure, suggesting a need for marketing interventions to mitigate continued e-cigarette use among young people.

Longer-term use of electronic cigarettes when provided as a stop smoking aid: Systematic review with meta-analyses

Moderate certainty evidence supports use of nicotine electronic cigarettes to quit smoking combustible cigarettes. However, there is less certainty regarding how long people continue to use e-cigarettes after smoking cessation attempts. We set out to synthesise data on the proportion of people still using e-cigarettes or other study products at 6 months or longer in studies of e-cigarettes for smoking cessation.We updated Cochrane searches (November 2021). For the first time, we meta-analysed prevalence of continued e-cigarette use among individuals allocated to e-cigarette conditions, and among those individuals who had successfully quit smoking. We updated meta-analyses comparing proportions continuing product use among individuals allocated to use nicotine e-cigarettes and other treatments.We included 19 studies (n = 7787). The pooled prevalence of continued e-cigarette use at 6 months or longer was 54% (95% CI: 46% to 61%, I2 86%, N = 1482) in participants assigned to e-cigarette conditions. Of participants who had quit combustible cigarettes overall 70% were still using e-cigarettes at six months or longer (95% CI: 53% to 82%, I2 73%, N = 215). Heterogeneity in direction of effect precluded meta-analysis comparing long-term use of nicotine e-cigarettes with NRT. More people were using nicotine e-cigarettes at longest follow-up compared to non-nicotine e-cigarettes, but CIs included no difference (risk ratio 1.15, 95% CI: 0.94 to 1.41, n = 601). The levels of continued e-cigarette use observed may reflect the success of e-cigarettes as a quitting tool. Further research is needed to establish drivers of variation in and implications of continued use of e-cigarettes.

A qualitative examination of e-cigarette use among California young adults during the EVALI outbreak

The 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) increased awareness of potential health risks associated with vaping among the general public. Little is known, however, about how unfolding information regarding EVALI affected knowledge, attitudes, and behaviors among e-cigarette users, particularly among young adults. This study describes attitudinal and behavioral responses to EVALI among young adult e-cigarette users. In October and November 2019, seven focus groups were held with college-going young adult tobacco users from two four-year public universities in California. Focus groups included questions regarding knowledge of and reaction to EVALI news, and how the news affected product use. Text from current e-cigarette users was extracted to develop individual phenomenological textural-structural descriptions of e-cigarette use for 38 individuals which were used to create a composite experience of e-cigarette use in light of EVALI. Experiences indicated that e-cigarette users were aware of information regarding EVALI and received information from numerous sources. Information was filtered for legitimacy of EVALI claims and causes of EVALI. Risk rationalizations were developed to assess potential harm of continued e-cigarette use and provided reasoning for behavioral responses to EVALI. The emerging harm associated with EVALI prompted e-cigarette users to engage in a cognitive process resulting in employment of a range of rationalities to justify continued use. These results suggest how environmental, cognitive, and behavioral factors may interact as young adults negotiate e-cigarette-related harms.

Commentary on Notley et al. : Understanding transitions in the use of nicotine and tobacco products-the value of qualitative longitudinal research.

Qualitative longitudinal research is an underused methodology in addiction research, but can provide valuable insights into transitions in the use of addictive substances, including e-cigarettes and tobacco smoking. Uncertainty concerning the efficacy of e-cigarettes as a smoking cessation aid has resulted in an increasing number of longitudinal studies measuring transitions in e-cigarette use and smoking status over time [1-3]. However, quantitative studies are limited in being able to determine what factors prompt individuals to make or maintain changes over time [4]. For this, we need narrative accounts of changes over time in nicotine and tobacco use. The paper by Notley, Ward & Dawkins [5] published in Addiction addresses this gap in the literature by presenting the results of a qualitative longitudinal study with 37 UK e-cigarette users who were using e-cigarettes to quit smoking, interviewing them twice approximately 12 months apart. This research demonstrates the type of insights that can result from qualitative longitudinal research. One key finding was that attitudinal differences about nicotine dependence seemed to influence continued use of e-cigarettes. The study found that those who were still using e-cigarettes and not smoking at 12 months thought long-term use of e-cigarettes was acceptable if it prevented relapse to smoking. However, those who had quit smoking and e-cigarettes (abstainers), and those who had relapsed to smoking, were uncomfortable with maintaining nicotine dependence. This aligns with quantitative research showing that while many e-cigarette users intend to continue using the products as a harm reduction strategy, others see it as a smoking cessation strategy and want to quit [6-8]. In order to identify e-cigarette users at risk of relapse to smoking, it may be helpful for health-care vprofessionals to ask users for their views on long-term nicotine dependence. Notley et al. [5] state that those who wish to quit e-cigarettes will need evidence-based information about how to do this while reducing the risk of relapse to smoking. However, research to inform recommendations for quitting using e-cigarettes is currently very limited. Some e-cigarette users report reducing nicotine concentration over time to reduce nicotine dependence, with the goal of eventually ceasing e-cigarette use [9]. An interesting finding of Notley and colleagues [5] is that some participants in their study who had continued to use e-cigarettes and remain abstinent from smoking had reduced their nicotine concentrations in order to ‘test’ their dependence. The effect of reducing nicotine concentrations over time is unknown, and randomized trials are needed to assess whether this is an effective means of quitting e-cigarette use without relapsing to smoking. A small number of studies have asked e-cigarette users whether they would like support in e-cigarette quit attempts, or whether they have sought such support when making quit attempts. In one survey study, Etter [6] found that of those who intended to quit vaping, 27% thought a health professional could assist them, 33% would visit a ‘vaping cessation service’ and 23% would use nicotine medications. A US survey study [8] found that of those who had attempted to cease e-cigarette use in the last year, 25% sought support from family or friends and 11% sought counselling or self-help materials. They also found that those who had used nicotine replacement therapy or cessation medications recommended their use [8]. The research by Notley et al. [5] also reveals factors that combine to influence trajectories of e-cigarette and tobacco use. Attitudes towards nicotine dependence, feelings of satisfaction with e-cigarettes, social exposure to smoking and vaping and life stressors all influenced individual trajectories. These are the complexities and nuances of individual lives that are difficult to capture using quantitative research. The value of qualitative longitudinal research for the addiction field is that it can explore the development of ‘narrative over time’ [10], and how these narratives are linked to the use of addictive substances. This has long been recognized in the ethnographic tradition of addiction research [11]; however, most qualitative studies in the addiction field remain cross-sectional. There are barriers to conducting qualitative longitudinal research [10]. Collecting and analyzing the data is resource and time intensive. Participant retention is critical due to the smaller sample sizes involved in qualitative research, although Notley et al. [5] demonstrate that very high retention rates are possible for nicotine and tobacco research. It would be of value to continue qualitative longitudinal research over periods longer than 1 year. This could be facilitated by embedding a qualitative component in longitudinal quantitative studies, where a subset of participants are interviewed to increase the depth of the study findings. The research reported by Notley et al. [5] shows that for research on smoking and e-cigarettes, longitudinal qualitative research is feasible and high retention rates are possible. The findings increase our depth of understanding of whether and why people transition between smoking, vaping and becoming nicotine-free. None.

Accessing Vaping Products When Underage: A Qualitative Study of Young Adults in Southern California.

California implemented multiple strategies, such as a Tobacco 21 law and compliance checks, to reduce high rates of youth e-cigarette use. However, the prevalence of use among underage youth and young adults continues rising. Little is known about how underage individuals obtain e-cigarettes. We conducted structured qualitative interviews with 61 young adult (18-25 years old) vapers in the Los Angeles, CA area between June 2018 and June 2019. Interviews were comprehensive and designed to elicit information on participants' thoughts, feelings, and experiences related to vaping. We queried participants on where and how they obtained vaping products, and participants discussed their experiences accessing products while under the legal age for sale. Directed content analysis was used to analyze interviews. Four concepts emerged: (1) early experimentation of e-cigarettes with peers often occurred in a school setting, (2) continued use of e-cigarettes commonly obtained through peer sales, (3) inconsistent implementation of age restrictions at in-person retailers, and (4) at online retailers. Participants had peers purchase products on their behalf and frequented in-person and online retailers with few to no age verification processes. Few participants faced challenges when purchasing products from retailers. The current study's findings offer insight into where and how underage individuals obtain vaping products despite restrictions to prevent them from doing so. Participant accounts of mixed ease of underage purchasing in-person and online suggest retailer education is needed, along with additional research to inform more effective policies to reduce underage access to vaping products. Despite legal age restrictions, e-cigarettes remain accessible to underage individuals, but specific strategies that underage youth utilize to evade legal age restrictions are largely unknown. We found that participants often accessed vaping products for the first time at school. Sales between peers were common, and participants also reported frequenting in-person retailers that inconsistently enforced age restrictions. Many participants reported little to no age verification online, though some believed online age verification measures were increasingly difficult to surpass. Knowledge of strategies underage youth utilize to access e-cigarettes can inform enforcement efforts.

A preliminary validation of the adolescent e-cigarette consequences questionnaire

IntroductionGiven the recent dramatic increase among adolescents in the use of electronic nicotine delivery systems (ENDS) or electronic cigarettes (e-cigarettes), there is a growing need to identify outcome expectancies that influence the initiation or continued use of e-cigarettes. While a self-report measure exists for assessing adolescent outcome expectancies for cigarette use, there is currently not one available for e-cigarette use. Validation and use of such a measure would provide insight into the growing popularity of e-cigarettes. MethodsThe sample consisted of 264 (50.76 % female, 86.36 % White, 84.47 % Hispanic/Latinx) freshmen and sophomores from South Florida high schools who were identified as at-risk for e-cigarette use. The current study adapted the Adolescent Smoking Consequences Questionnaire (ASCQ) to derive the Adolescent E-Cigarette Consequences Questionnaire (AECQ) to characterize e-cigarette outcome expectancies. A confirmatory factor analysis was estimated to test the underlying factor structure. ResultsThe confirmatory factor analysis provided support for a seven-factor structure (negative affect reduction, taste/sensorimotor manipulation, social facilitation, weight control, negative physical feelings, boredom reduction, and negative social impression) after removing two items with low factor loadings from the social facilitation subscale. After removing these items, factor loadings ranged from 0.46 to 0.86. ConclusionThe current study provides preliminary evidence to suggest that the Adolescent E-Cigarette Consequences Questionnaire is a psychometrically sound measure. Future work should continue to test this measure among diverse samples of adolescents (e.g., non-Latinx samples) with varying levels of use.

What influences adolescents to continuously use e-cigarettes?

The use of e-cigarettes is rapidly increasing in adolescents. Health care providers pay attention to e-cigarette users because of the risk of developing addiction and problematic behavior. Based on ecological perspective, this study investigated factors influencing continued e-cigarette use. We classified 1556 current e-cigarette users into experimental and continued users using the Korean national representative data. Data were analyzed using the chi-square test and logistic regression based on a complex sample analysis. Among current e-cigarette users, 55.1% were continued users. Adolescents who use e-cigarettes because of the belief that they are less harmful than cigarettes, concealment, easy purchase, and adding various flavors had a high risk of continued use. Continued users were more likely to have a higher weekly allowance, lower rate of living with family, and higher chance of smoking parents and exposure to passive smoking at home. Continued e-cigarette use was influenced by interpersonal and environmental factors, such as ease of purchase and addition of flavoring substances. Improving the environment of adolescents can prevent continued use of e-cigarettes.

Which smokers adopt e-cigarettes and at what price? An experimental estimation of price elasticity of demand and factors correlated with e-cigarette adoption

E-cigarette use has surged in recent years. Many of these new users are cigarette smokers. It is unclear whether e-cigarette adoption by smokers will lead to improved public health due to uncertainty about whether e-cigarettes help smokers quit using cigarettes and about whether ongoing dual use reduces exposure to toxins. A third source of uncertainty is whether providing cigarette smokers with sample e-cigarettes increases e-cigarette adoption. To provide insight into this final issue, we follow up with cigarette smokers who left an experimental auction with an e-cigarette, contacting them after two weeks, six weeks, and six months to determine which demographic and smoking-related characteristics predict continued e-cigarette use. We find that smokers who have made a serious quit attempt, have been advised to quit smoking, or have previously tried e-cigarettes are significantly more likely to report continued e-cigarette use. Women and smokers from racial and ethnic minority groups are significantly less likely to use e-cigarettes at follow up, as are those who said they would rather quit than switch to e-cigarettes. We also use experimental auction bids to estimate the price elasticity of demand for e-cigarettes, finding that a 10% increase in price results in a 5.6% reduction in quantity demanded. This suggests e-cigarette demand is less price sensitive than some earlier studies have found. While a tax on e-cigarettes can still be an effective tool for reducing e-cigarette demand, the reduction in demand may be smaller than some earlier studies would suggest.

E-cigarette Dependence Measures in Dual Users: Reliability and Relations With Dependence Criteria and E-cigarette Cessation.

Electronic cigarettes (e-cigarettes) have drastically changed the nicotine and tobacco product landscape. However, their potential public health impact is still unclear. A reliable and valid measure of e-cigarette dependence would likely advance assessment and prognostication of the public health impact of e-cigarettes. The aim of this research was to examine the internal consistency, structure, and validity of three e-cigarette dependence scales. Adult dual users (smokers who also vape, N = 256) enrolled in an observational cohort study (45.1% women, 70.7% white). At baseline, participants completed the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM), and the Penn State Electronic Cigarette Dependence Index (PS-ECDI). All participants provided a urine sample for cotinine analysis and reported e-cigarette use at 1 year. The e-WISDM subscales had the highest internal consistency (α = .81-.96), then the PS-ECDI (α = .74) and e-FTCD (α = .51). A single-factor structure for the e-FTCD and an 11-factor structure for the e-WISDM were supported, but the PS-ECDI did not have a single-factor structure. All three e-cigarette dependence scales were highly correlated with validation criteria including continued e-cigarette use at 1 year, but not with e-liquid nicotine concentration or cotinine. The e-WISDM and PS-ECDI had stronger internal consistency than did the e-FTCD, despite the e-FTCD's single-factor structure, but all 3 measures appear to be valid measures of e-cigarette dependence as suggested by their significant relations with self-perceived addiction, heavy use, early use after overnight deprivation, and continued use over time. This research provides empirical support for three e-cigarette dependence measures: the e-FTCD, the PS-ECDI, and the e-WISDM among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.

Vapers and vaping: E-cigarettes users views of vaping and smoking

The use of electronic cigarettes has increased markedly in recent years, however, as the popularity of e-cigarettes has increased, so has the controversy associated with their use. In this paper we report the views of a small sample of e-cigarette users focussing on the circumstances in which individuals began vaping, their reasons for continuing vaping, their perceptions of the relative harm of vaping compared to smoking, and their views as to whether their use of e-cigarettes had increased their likelihood of smoking. In total we interviewed 50 vapers aged between 16 and 26. Typically, vapers explained their continued use of e-cigarettes in terms of the reduced harm compared to smoking, the lack of an offensive smell, the appeal of different flavours, the greater range of settings in which e-cigarettes could be used, and the reduced stigma associated with their use. The sample of interviewees were evenly split with regard to the perceived justification (or not) for banning vaping in public. Finally, we make the case that it is important to base policy and regulation of e-cigarettes on both robust epidemiological data on the impact of these devices as well as more qualitative, ethnographic, information from users themselves.

Reasons for Trying E-cigarettes and Risk of Continued Use.

Longitudinal research is needed to identify predictors of continued electronic cigarette (e-cigarette) use among youth. We expected that certain reasons for first trying e-cigarettes would predict continued use over time (eg, good flavors, friends use), whereas other reasons would not predict continued use (eg, curiosity). Longitudinal surveys from middle and high school students from fall 2013 (wave 1) and spring 2014 (wave 2) were used to examine reasons for trying e-cigarettes as predictors of continued e-cigarette use over time. Ever e-cigarette users (n = 340) at wave 1 were categorized into those using or not using e-cigarettes at wave 2. Among those who continued using e-cigarettes, reasons for trying e-cigarettes were examined as predictors of use frequency, measured as the number of days using e-cigarettes in the past 30 days at wave 2. Covariates included age, sex, race, and smoking of traditional cigarettes. Several reasons for first trying e-cigarettes predicted continued use, including low cost, the ability to use e-cigarettes anywhere, and to quit smoking regular cigarettes. Trying e-cigarettes because of low cost also predicted more days of e-cigarette use at wave 2. Being younger or a current smoker of traditional cigarettes also predicted continued use and more frequent use over time. Regulatory strategies such as increasing cost or prohibiting e-cigarette use in certain places may be important for preventing continued use in youth. In addition, interventions targeting current cigarette smokers and younger students may also be needed.

Use of electronic cigarettes among secondary and high school students from a socially disadvantaged rural area in Poland.

BackgroundThe use of e-cigarettes has been growing and has become a significant public health concern. Prevention of the youth access to, initiation and continuous use of e-cigarettes with special attention to vulnerable groups is a subject of a health debate. However, still little is known about characteristics of the underage e-cigarette users from different geographic and socio-economic backgrounds as well as other potential factors associated with the use of e-cigarettes, including simultaneous use with tobacco products or alcohol. The aim of the study was to investigate the prevalence and factors associated with ever and continued e-cigarette use among the secondary and high school students from a socially disadvantaged rural area in Poland.MethodsThe study sample consisted of 3552 students aged 13–19 years from Piotrkowski district. The anonymous, self-administered questionnaire adapted from the Global Youth Tobacco Survey was implemented to collect relevant information. The uni- and multivariate logistic regression analyses were applied to identify factors associated with ever, current (in the previous 30 days) and continued e-cigarette use.ResultsAlmost 22 % of the sample reported ever e-cigarettes use and 27 % of the respondents indicated e-cigarettes use in the past month. Boys, in comparison with girls, were more likely to report current e-cigarette use (OR = 1.7; p < 0.001). Current e-cigarette use was strongly associated with alcohol consumption (OR = 4.3; p < 0.001), current (OR = 32.5; p < 0.001) and ever tobacco smoking (OR = 7.5; p < 0.001) as well as smoking parents (OR = 1.4; p < 0.05) and friends (OR = 4.5; p < 0.05). The use of e-cigarettes was also significantly associated with harm perception (p < 0.001). A similar pattern was observed among ever e-cigarette users. Male gender (OR = 1.4; p < 0.05), current tobacco smoking (OR = 3.0; p < 0.01) and lack of knowledge about a ban on smoking in the school (OR = 1.4; p < 0.05) were predictors of the continued e-cigarette use. Higher paternal education (OR = 0.5; p < 0.001) and perception of e-cigarettes as more harmful comparing to tobacco (OR = 0.2; p < 0.001) protected from the continued e-cigarette use.ConclusionsE-cigarette use is widespread in the investigated population, especially among boys, those with other risky behaviors and with smoking parents or friends. There is a need for further research and preventive policies to protect the youth from that exposure.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3417-y) contains supplementary material, which is available to authorized users.

Abstract CN02-03: Quitting or switching? Health benefits and risk of electronic cigarettes

Abstract Although the best way for smokers to avoid the health risks associated with smoking is to quit smoking altogether, for those who do continue to smoke the application of an exposure reduction (“harm reduction”) strategy could result in substantial reductions in mortality and morbidity. Many smokers are concerned about the health effects of smoking and might be interested in trying new products if they believed this would reduce their health risk. The concept of exposure reduction is based on the principle that if dangerous behavior, like smoking, is likely to continue, the harm caused should be minimized. One such approach for continuing smokers would be to promote the substitution of alternative, less toxic means of delivering nicotine, assuming that these were proven to be less hazardous than tobacco smoking and did not cause any additional health risks. Electronic nicotine inhalers, commonly called electronic cigarettes or “e-cigarettes”, represent a new stage in which nicotine is delivered in a method that simulates smoking but without involving a tobacco combustion process. E-cigarette are battery-powered devices that provide inhaled doses of nicotine by delivering a vaporized liquid nicotine solution, usually including propylene glycol or glycerin. The nicotine is extracted from tobacco leaves (in the same way the pharmaceutical industry obtains nicotine for NRT production), and is then diluted and introduced into the e-cigarette's cartridge. In addition to delivering nicotine, the vapor also provides a flavor and physical sensation similar to that of inhaled tobacco smoke, although no tobacco or combustion is actually involved in its operation. When a user initiates inhalation into the device, air flow is detected by a sensor, which activates a heating element that vaporizes the nicotine solution stored in the mouthpiece cartridge. It is this vapor that is inhaled by the user. On some models an LED on the opposite end of the device is activated during inhalation to serve as an indicator of use as well as simulating the glow of burning tobacco. E-cigarettes have been shown to reduce craving and withdrawal symptoms in abstinent smokers and, as nicotine is delivered without tobacco combustion, are thought to be substantially safer than cigarettes. While e-cigarette use is rapidly increasing, relatively little is known about their efficacy for smoking cessation, particularly compared with established nicotine-containing pharmacological aids. One randomized controlled trial by Bullen et al. showed that e-cigarettes are at least as effective as nicotine patches for smoking cessation. Interestingly, a substantial proportion of participants in this study engaged in harm reduction, becoming long-term e-cigarette users and reducing their conventional cigarette consumption. Thus, against the backdrop of ongoing debates on tighter regulation of e-cigarettes, a sole focus on smoking cessation may be misguided. From a public health perspective, the permanent switch from combustible to noncombustible products is an important endpoint in itself. Nonetheless, the finding that e-cigarettes are at least as effective as existing licensed, nicotine-containing smoking cessation products should go some way towards easing, if not completely allaying, the fears of many health professionals observing their fast uptake among smokers. Distributors of e-cigarettes promote the product as completely free of harmful substances. However, nicotine solutions used in e-cigarettes vary with respect to concentrations of toxicants, and the quality control in e cigarette manufacturing is questionable. Although a number of toxicants have been identified in e-cigarette vapors, the levels of these toxicants are orders of magnitude lower than those found in cigarette smoke, but higher than those found in Nicotine Replacement Therapy (NRT) products. Some studies suggest that vapor from e-cigarette is significantly less cytotoxic compared to tobacco smoke. One study found that after switching from tobacco to electronic cigarettes nicotine exposure is unchanged while exposure to selected toxicants is substantially reduced. Although it cannot be said that currently marketed e-cigarettes are safe, e-cigarette vapor is likely to be much less toxic than cigarette smoke. The devices likely pose less direct hazard to the individual smoker than tobacco cigarettes and might help smokers quit smoking or reduce harm by smoking fewer cigarettes. The use of e-cigarettes as a harm reduction strategy among cigarette smokers who are unable to quit, warrants further studies. Further research is needed to evaluate long term effects of switching, including the health effects of continued use of e-cigarettes. Citation Format: Maciej Lukasz Goniewicz. Quitting or switching? Health benefits and risk of electronic cigarettes. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr CN02-03.

Abstract SS02-03: Carcinogens and toxicants in e-cigarettes

Abstract SS02-03: Carcinogens and toxicants in e-cigarettes